Improving the Follow-Up of Positive Hemoccult Screening Tests: An Electronic Intervention
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Four population-based studies of screening for CRC with fecal occult blood testing (FOBT) have shown that mortality can be significantly reduced. However, nearly half of all positive screening tests are not appropriately evaluated.
We evaluated whether an electronic record intervention improved the follow-up of patients with a positive FOBT (FOBT+) result.
We conducted a cluster randomized trial involving four Veteran’s Affairs (VA) medical centers pair-matched by colonoscopy volume and randomized within the pair to receive the electronic intervention or usual care.
All patients with FOBT+ results at participating facilities during a matched pre- and post-intervention time period.
In the two intervention sites, an electronic consult that imported relevant clinical information was automatically submitted to the gastroenterology (GI) clinic for all FOBT+ patients at the time the result was recorded in the laboratory. In both intervention and control sites (usual care), PCPs continued to be notified of FOBT+ results in the usual manner
Pre- and post-intervention changes in the proportion of FOBT+ patients having: (1) a GI consult or (2) a GI consult plus complete diagnostic evaluation (CDE) of the colon within 30, 90 and 180 days were compared across intervention and control sites. Log rank tests were used to determine statistical significance.
The 30-, 90- and 180-day GI consult rates improved 21–33 % (p < 0.001) among intervention sites, but did not change in the usual care sites. Thirty-, 90- and 180-day CDE rates improved 9–31% (p < 0.03) in intervention sites, but did not significantly change in the usual care sites. Time to GI consult and CDE decreased significantly over time in the intervention sites (p < 0.001), but remained unchanged in the usual care sites.
The relatively simple electronic intervention evaluated can significantly improve the follow-up of FOBT+ results. Interventions such as this could improve patient care and may be applicable to other practice settings, as well as other types of tests.
KEY WORDScolorectal cancer cancer screening cancer prevention
This research was funded by VA HSR&D grant number CRT-02-059. This publication was made possible with support from the Oregon Clinical and Translational Research Institute (OCTRI); grant number UL1 RR024140 01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH); and NIH Roadmap for Medical Research. The funding organizations had no direct involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. We are grateful for the help of Barbara Genovese, MS; Courtney Maxcy, BS; Paige Farris, MSW; David Pauly, MBA, MSW; David Lieberman, MD; Joan Ash, PhD; Robert Socherman PhD; David Douglas, MD; and Michele Freeman, MPH, in the completion of this study and manuscript. We also acknowledge the help of the many co-investigators and programming staff involved with this study at each of the participating sites.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
Conflict of Interest
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